Thursday, December 30, 2010

Health Reform Benefits in 2011

It’s the new year, and that means new benefits from the Affordable Care Act (also known as the health reform law.) Seniors enrolled in Medicare’s prescription drug plan (Medicare Part D) will spend out of pocket. Currently, when a people with Part D have used $2,830 of their drug benefit, they are required to pay the entire cost until they reach a certain threshold. This is called the Part D coverage gap, or the “doughnut hole”. With the ACA, pharmaceutical companies are required to provide consumers with a 50% discount on all non-generic drugs while they’re in the coverage gap, and a 7% discount on generic prescription drugs. Although seniors will be paying less for their medications while in the coverage gap, the full price will be applied, getting them through the gap more quickly. By 2020 the coverage gap will go away entirely (see the AARP for further explanation).

Also effective January 1st is the implementation of the minimum medical loss ratio. We wrote about this previously; it requires that insurers spend at least 80% of the premiums they collect on medical care, instead of on advertising or paying their employees.

Doctors will soon find it easier to care for patients relying solely on Medicare. Although most physicians continue to accept Medicare, some primary care physicians find it quite hard to provide their patients with necessary services on the rates they are paid. Starting January 1st, Medicare payments for primary care and general surgeons in shortage areas will rise by 10%. Unfortunately, this increase will only last through 2015, at which point Congress will likely have to address the issue again.

Also effective January 1, seniors on Medicare will no longer have to pay copays for some preventive services. This will be limited to services that have been rated “A” or “B” by the United States Preventive Services Task Force. These are services that, based on available evidence, are likely to provide either moderate or substantial benefit, either by improving well-being or preventing death. This includes screening for elevated blood pressure, cervical cancer, cholesterol, colon cancer, vision testing in children, counseling for tobacco abuse, screening for osteoporosis, and many other services. Although there is disagreement among different experts regarding breast cancer screening, the ACA also covers mammograms for all women over 40, although the USPSTF no longer recommends routine mammograms for women under age 50.

Another small change you’ll notice is nutritional labeling for all food sold at chain restaurants and in vending machines. We already have nutritional labeling in New York City. There is no evidence that knowing how many calories are in the meals bought at chain restaurants changes behavior, or even that people understand what the numbers mean, but for some people knowing the information is valuable (starts in March).

We can also expect some smaller programs aimed at sparking innovative approaches to improve the way we deliver health care. The Center for Medicare and Medicaid Innovation will design and implement multiple small projects by consulting with stakeholders, including medical providers, insurers, and patients, to improve the quality of medical care by streamlining what is often a fragmented system. The goal is to find new models of health care delivery that will improve care and save money. For more information see the CMS innovations site. Another smaller project will give increased Federal support for 2 years to patient-centered medical homes (also known as health homes).

In Graduate Medical Education, Teaching Health Centers (where residents, or doctors-in-training who have finished medical school) will be funded as residency sites for 5 years. Residency slots will be redistributed to favor primary care training. These changes will occur in July.

Some other behind-the-scenes changes include grants to help Medicaid enrollees develop healthier lifestyles, as well as grants to small employers to develop similar wellness programs. States will receive grants to start planning their insurance “markets”, also known as the American Health Benefit Exchanges and the Small Business Health Options Program Exchanges. Enrollment in the Exchanges is planned for 2014.

Cost-saving measures include no longer paying hospitals for certain preventable infections acquired in hospitals; restructuring Medicare Advantage programs so that they are no longer subsidized at the expense of other Medicare beneficiaries (currently Medicare Advantage plan members receive extra benefits when compared with traditional Medicare beneficiaries, due to a 13% increased payment to the plans compared to those on traditional Medicare; the subsidy will decrease to 1% on average, but it will vary from state to state. See the Wall Street Journal for more information. Those with tax-free health savings accounts will only be able to over-the-counter drugs covered if prescribed by a physician. Individuals earning over $85,000 per year (couples earning more than $170,000) will continue to pay premiums for Part B coverage, but instead of having this threshold increase yearly it remains frozen. This will only affect about 5% of Americans. Similarly, about 3% of Part D enrollees will be subject to a new premium for this drug benefit program. These changes are in effect on January 1st.

Several other provisions include changes to long-term care, an optional disability insurance program, and several other items. For a full explanation see the Kaiser Family Foundation or

The vast majority of Americans will see many benefits from these changes. A small percentage will benefit, but also will have to pay more for some of their benefits; some may end up saving money despite this increased cost due to full coverage of preventive services.

Thursday, December 23, 2010

The grinch who stole health care reform?

Families USA does a great job reminding us of all the good the Affordable Care Act has already done with their holiday-themed post, "Five things the health care grinches don't want under your tree this year." The Republicans (and some Democrats) are looking forward to dismantling the law. We hope they don't want to roll back everything we've gotten so far: coverage for all kids regardless of health problems, no cost-sharing for most preventive services in new health plans, help for businesses to cover their employees, coverage for young adults, and new high risk pools for people with pre-existing conditions. Plus there's more to come in January of 2011, including lower drug costs for seniors on Medicare; free preventive services for seniors; requirements for insurance companies to spend premiums on care, not on advertising; and help coordinating safe discharges from hospital to home for vulnerable patients. Read more at Families USA's Stand Up for Health Care project and at

Happy holidays, and we look forward to working with all of you next year as week keep fighting for health for all.

Monday, December 13, 2010

Reform law repeal? Unlikely; many benefits already in effect.

Since the Patient Protection and Affordable Care Act (PPACA, also known as the health reform law) was signed into law, its detractors have been bringing lawsuits everywhere they can find a willing prosecutor. More than 20 suits have been filed around the country, several of which have been dismissed (in Michigan and Virginia), and the majority of which are pending. On December 13th, the lawsuit in the Eastern District of Virginia was upheld when the judge ruled the mandate for individuals to buy insurance was unconstitutional, and that the Commerce Clause (regarding regulation of interstate finance) does not allow for a mandate to purchase health insurance (for a complete listing of lawsuits and their status, see The Washington Post). Other clauses are also an issue, but I'll leave that to the experts. Although the judge ruled that component of the law unconstitutional, the rest of the law is not affected.

Some constitutional scholars seem less than pleased with this ruling. Professor Stephen Schwinn, at the American Constitution Society Blog, notes that the decision goes far beyond a ruling on the individual mandate. He argues that the ruling is consistent with rolling back decades of judicial thought and returning the role of the courts to those of the first half of the 20th century. At that time, the Commerce Clause was defined quite narrowly, allowing the courts to obstruct congressional activity considerable. In the late 1930s, the courts moved to a more pliant interpretation of the Commerce Clause, taking into account the complexity of our modern economy. (Please read more about it here as I am not a lawyer). President Obama, himself a Constitutional scholar, clearly believes this law to be appropriate and within the mandates of the Constitution. There are, of course, some scholars who disagree and believe that requiring people to purchase health insurance is not allowed by the Commerce Clause. Most likely this will end up in the Supreme Court, according to policy watchers.

Most supporters of the PPACA believe that an individual mandate to buy insurance is required. Although the individual mandate was in part a bargaining chip to bring insurers on board to support health reform rather than bring their full advertising muscle against it, it also has value in making the system sustainable. If people are not required to buy health insurance but insurers are required to sell it to everyone regardless of their medical history, some people will simply wait until they’re ill to buy the insurance. If everyone does this, there won’t be enough money in the system to pay for expensive hospital stays or surgeries for those who are ill. As a result, everyone who does pay insurance will have to pay more to cover those who are sick, while others get a free ride. Worse, people may still not even buy insurance when they’re sick, then not pay their medical bills. Again, everyone else ends up having to pay more to make up for the people who don’t pay their part. (Here’s a helpful (if dry) video from the Kaiser Family Foundation that explains the concept of the individual mandate more thoroughly)

Nobody wants to have to pay for insurance, especially if they don’t think they need it. On the other hand, none of us want to see our friends, family, and neighbors suffer because they can’t afford to see a doctor. In addition, most people will qualify for coverage that is either free or significantly subsidized. Ironically, many of those calling for repeal are those who will have free health care in 2014 when the full effects of the law take place.

The health reform law is already benefiting many people, by requiring insurers to cover preventive services, eliminating pre-existing conditions for children, extending coverage to young adults, and creating special insurance plans for people with pre-existing conditions (see for details on all of these provisions). In 2014 it will benefit far more people, with improved eligibility for Medicaid, subsidized insurance options for the majority of Americans who are uninsured, elimination of denials for coverage for pre-existing conditions, and many other changes. (Find out how much you can expect to save with the Kaiser Foundation’s subsidy calculator)

The individual mandate is just one part of a large reform package meant to improve the way people get health care in the US. While its future remains uncertain, the remainder of the plan is intact, and many more benefits can be expected in the future.

Thursday, December 9, 2010

More good news for consumers as a result of the Affordable Care Act: No more “mini-med” plans

HHS recently released guidance regarding limited benefit insurance plans. These plans tend to be much less expensive than more comprehensive plans. The tradeoff, unfortunately, is that coverage falls short of what’s needed when the subscriber gets sick. Some plans only pay $100/day in the hospital (which the true cost can be well over $1,000/day), or have extremely low maximum benefits of only a few thousand dollars.

These plans are fine for those who are healthy, but any chronic condition or any acute event will rapidly exhaust the coverage, leaving the subscriber without any way to pay for needed care. This is the reason such plans will no longer be permitted starting in 2014.

In the meantime, those people who have no other choice but to continue to use such plans now have increased protection. The plans must make the limits of coverage clear to all subscribers, and must provide information on how to access more options through the website. New limited benefit plans are not allowed (with some exceptions), and existing limited plans will have to obtain waivers to continue operating, and will no longer be allowed at all in 2014.

Although this will make insurance prices go up for some in the future, at this time it ensures consumers know what they’re getting and know where to go to find out about more comprehensive plans. Although the limited benefit plans are better than nothing, people deserve the peace of mind that comes with not worrying if the next medical problem they face will lead to bankruptcy.

Friday, December 3, 2010

Town Hall in Brooklyn December 2nd, 2010

NPA New York Local Action Network cosponsored an event on December 2nd with multiple organizations** entitled “Health Reform: The Battles Ahead in Albany and Washington.” Those who attended were fortunate to hear from New York experts Dr. John McDonough (Distinguished Fellow in Public Health at Hunter College); Mark Hannay (Director of Metro New York Health Care for All); Kinda Serafi (Senior Health Policy Associate at the Children’s Defense Fund); NPA’s Dr. Bill Jordan (NPA board member and co-chair of health policy for the Public Health Association of New York), Jenny Rejeske (Director of Health Advocacy for the New York Immigration Coalition), and Lois Uttley (Director of the Mergerwatch Project, co-founder of Raising Women’s Voices for the Health Care We Need, and Board Member of PHANYC).

Dr McDonough began the talk with an overview of the provision of the Health Reform Act, also known as the PPACA. The goal of the act is to improve access to health care through nine different measures:

1) Affordable and available coverage through creation of an insurance exchange and subsidies

2) Reforms of Medicaid and CHIP (Child Health Insurance Program) to increase the number of people eligible by changing income requirements and covering single adults

3) Delivery system reforms to lower the rate of spending increase throughout the system

4) Prevention and wellness initiatives to improve access to preventive care by eliminating cost-sharing for most preventive services and creating a national program to promote wellness & prevention

5) Workforce initiatives to improve access to primary care

6) Eliminating fraud and abuse

7) Improving access to generic versions of certain expensive medicines

8) New affordable private voluntary disability insurance

9) Attain revenues by increasing taxes on the most wealthy (with an income over $200,000 for individuals, $250,000 for families) and on unearned income, as well as taxes on indoor tanning salons

He also explained how the reforms enacted would not only pay for themselves, but would end up saving billions of dollars by decreasing costs of health delivery, decreasing costs of taking care of the uninsured nationwide, and reforming the way Medicare and Medicaid work to make them more efficient.

Following Dr McDonough, Mark Hannay explained where we are in New York with this law, and where we have to go to truly make sure all New Yorkers have affordable access to health care. Because most of the implementation of this law falls to the states, we have a tremendous opportunity to turn New York’s program into a model for other states. New York has about 2.7 million uninsured right now, of whom about 2 million will be insured once the law takes effect.

Kinda Serafi discussed the advantages of this law for many people who currently are uninsured. One of the challenges will be to make application for these programs accessible for all. Currently, Medicaid applications can be so long and daunting, or stigmatizing, that many New Yorkers who qualify do not apply. On implementation, the best case scenario would be to create a system accessible to everyone, by phone, mail, internet, or in person, that could help individuals and families determine what plans they’re eligible for, how much they will cost, and other details. Although this would require an extensive overhaul of the Medicaid eligibility system, which is currently quite antiquated, but would be well worth the investment.

Dr. Bill Jordan spoke about the challenges posed to the health care workforce by this law. As it is, there aren’t enough primary care doctors to meet demand. When millions more people flow into the system with their new health coverage, we need to make sure there are enough doctors to care for them. To help with this, the PPACA increases loan repayment for primary care providers, redistributes residency training slots to favor primary care sites and rural, underserved areas, and also redirects training funds to increase the supply of general surgeons.

Jenny Rejeske discussed the impact of the law on immigrants. As a group, many immigrants have much to gain from this law. Some immigrants, those who are undocumented, are left behind. The majority of immigrants will benefit as the most are here with legal status, either as residents or as naturalized citizens. The key will be to ensure that those eligible for Medicaid and other subsidies are aware that these programs are available to them. In addition, we need to ensure that undocumented immigrants are connected to the health care services available to them, including patient financial assistance at all hospitals that accept federal funds, as well as community health centers and HHC clinics and hospitals for those living in New York City.

Lois Uttley finished up by talking about women’s health. In terms of women’s health, there are great gains for most women, in that maternity care will be a mandated service starting in 2014, and preventive services must be provided without a deductible for new insurance plans starting this year (meaning mammograms, pap smears, and STI testing are now free to all women regardless of which insurance plan they use). The negative for women will be the restrictions on abortion coverage for all new insurances bought through the exchange, as well as a likely similar effect even on those who have insurance now. The law states that each state has the right to limit, prohibit, or restrict coverage abortion in all insurances sold on the exchange (14 states have already taken advantage of this). Even where abortion coverage is allowed, participants in those plans have to write 2 separate checks to the company, one to cover abortion and one for everything else.

Attendance at the event was impressive at 115. Audience members asked important questions to clarify the impact of the law on immigrants and children, as well as the future structure of the health care system.

Thanks to all the co-sponsors, panel members, and attendees!

**Co-sponsors of this event were: Long Island University School of Health Professions, AARP-NY, PHANYC, Children's Defense Fund-NY, Community Service Society, Committee for Interns and Residents - SEIU, Health Care for All New York, Health Care Leaders of New York, New York Immigration Coalition, National Organization for Women - New York State,
 and Raising Women's Voices for the Health Care We Need

Monday, November 22, 2010

Medical loss ratio ruling - good news for those with individual insurance policies

On November 22nd, the Department of Health and Human Services issued rules regarding a part of the health reform law known as the medical loss ratio. The new rules require that all insurers must spend at least 80% of the premiums they collect from customers on direct medical care. Currently, some insurers spend as little as 70% of premiums on medical care, such as doctor and hospital bills and quality improvement initiatives with the rest of the money going to overhead such as administrative costs, advertising, and profit. The new rules should help some consumers see decreased insurance costs, though the insurance companies have been lobbying heavily to have as many expenses as possible classified as direct care costs. In the end, though, insurers will not be able to classify running customer service hotlines, executive pay, and other administrative costs as direct care, so they will now have much more of an incentive to spend more money on patient care and less on administration. Some subscribers might actually get a check in the mail as a rebate on their coverage if it turns out the insurer charged too much money.

This will mostly only apply to people who buy insurance individually; people who get insurance through their employer (if their employer is a large business) will likely not see any change or get any rebate, as most group insurers have a medical loss ratio of 85-90% because of improved administrative efficiency and decreased need to advertise to individuals.

Of course, when we look at Medicare our requirement of a medical loss ratio of 80% seems excessively generous; Medicare’s medical loss ratio is 98-99% because their administrative costs are so low. In other words, of the tax money we give to Medicare, only 2% at most goes to overhead. This is one of the arguments made by single payer advocates; by not having to advertise, by having streamlined enrolment, reimbursement, and funding streams, and by not having to profit from providing care or pay executives, Medicare saves lots of money.

This new ruling on the medical loss ratio doesn’t get us anywhere near the efficiencies enjoyed by Medicare, but it’s a good first step.

Saturday, November 13, 2010

Support New York City's Women

One-third of women will have an abortion at some time in their lives. For years, New York City residents seeking abortion care have had to contend with the existence of so-called "pregnancy resource centers" (also known as crisis pregnancy centers, or CPCs) located near clinics that provide abortion services. These "resource centers" are intentionally placed near free-standing abortion clinics such as Planned Parenthood in the hopes of luring women seeking a medical service into their doors. The centers rarely have any medical personnel, and have as their mission to prevent women from choosing abortion (see this recent New York Times article for more information). They often do so using misleading information, and they do so with the help of our tax dollars, according to a 2006 report commissioned by Representative Henry Waxman.

Because CPCs misleadingly claim to provide medical services and full spectrum pregnancy options, doctors, women, and women's advocates have been rallying to make sure women have full information of what they can expect when walking in the door. Baltimore recently passed legislation that would require CPCs to clearly post signs stating that they do not offer or refer for abortion or contraception services.

On November 16th 2010 at 1:00 PM, the New York City Council will be hearing testimony from the public to consider similar legislation here. I strongly urge any of our New York physicians who take care of women to either attend the meeting or submit testimony directly to the Council.

This is not about the morality of abortion, or judgements about the choices women make. This is about every patient's right to accurate information and to access routine medical services.

Thursday, October 7, 2010

To Speaker Quinn: Support the Paid Sick Time Act!

So often, in my office, someone will come in clearly having waited to come see me. I used to wonder why people waited so long- why did they walk around in debilitating pain until they couldn't walk, why did they let their child stay sick and infect everyone else in the household, etc etc. It's not that people don't know better, or that they don't want to. It's often that they can't afford to. And not being able to get off work is frequently the reason. Either out of concern that they may get fired, or because they can't afford not to get paid. And of course, the jobs that are least likely to provide paid sick time are also the ones that pay the least, leaving hard working people- single mothers, manual laborers, young adults- with hard choices to make. Is it going to be rent or going to the doctors this month? No one should ever have to make that choice.

So a coalition of physician advocacy organizations decided to visit City Council Speaker Christine Quinn's office today. Dr. Bill Jordan and I from NPA-New York joined with members of CIR (including our ring leader, Tim Foley) and Doctors for America. We learned that although the Council had heard from a few health care professionals, it seemed that the physician voice had been missing. And that the business interests had been the overwhelming lobby in their office. It was important for us to show them how this affected real people, and how the health care field was accomodating this reality.

We told them stories of our patients. The first one that came to my mind was during my second job as a Sexual Assault Forensic Examiner. This young woman had come in late on a Friday night after having been sexually assaulted- on Wednesday. Often people come several days after the assault because of fear and shame, but that wasn't the case with her. She came 2 days later because she had to work, as she was the main breadwinner in the house, since she was taking care of her bed-bound mother and siblings. Besides not having time to be able to process this traumatic event until a few days later, she was also too late to get medicines to reduce her chances of contracting HIV, and the morning after pill I gave her was much less effective 2 days later. No one, no one, should have to go through this- not the assault, and not the 2 days of waiting.

Others told stories of people resorting to using the Emergency Room for their care, because they couldn't take time off during the day. We spoke about how many of our clinics had shifted their hours to a later time, as well as on weekends, to accomodate for this. We reminded them that contagious illnesses know no bounds. We recounted the conversations we've had with our patients trying to convince them that they need to take time of work because they are sick and need rest or to not transmit their illness to others- often falling on deaf ears because that person cannot afford the time.

We really hope that Speaker Quinn and her colleagues in the City Council hear our voices, and pass the Paid Sick Time Act.

Tuesday, October 5, 2010

Why we support the New York City Paid Sick Time Act

This week, a coalition of advocacy groups is advocating for the passage of the New York City Paid Sick Time Act. The idea of this act is that all workers deserve paid sick days. It's hard to believe, but only 37% of the lowest paid workers have any paid sick leave available to them. These are the workers who are most likely to be living paycheck to paycheck, and the least likely to be able to afford a day off from work when they or a family member are sick. This is harmful not only to workers and their families, but also to all of us. If a mother can't take time off to care for her sick child, that child may end up going to school and infecting his classmates, and the mother goes to work and passes the infection on to her colleagues as well.

Workers who don't take time off when they or a family member are sick aren't selfish people who don't care about the effects of their behavior on their neighbors. They are people who simply cannot afford to miss even a day of work, or who can't afford a baby sitter for a sick child even for one day. These people suffer, as do their family members.

When I was working in the pediatric emergency department a few years ago, I evaluated a seven-year-old girl who was having a severe asthma attack. She had a history of mild asthma, and usually only needed medications a few times a year, but she was suffering from the kind of attack that I usually see only in children with severe asthma. When I spoke with her mother, she revealed that she had contracted a cold a week earlier, and for the last three days was having more and more trouble breathing.

It was about 11:30 PM. I asked the mom why she hadn't brought her daughter in sooner. Her face immediately fell, and she started crying. She explained that she knew her daughter was sick, but she was unable to change her work schedule. She was a home health aide, a job at the bottom of the pay scale that rarely comes with benefits. She explained that her rent was late and she simply couldn't take an unpaid day off. Unfortunately, because her daughter had been sick for so long before she came to the hospital she required admission overnight. If she had seen her pediatrician earlier that week she likely would have avoided the ED visit and hospitalization entirely.

Yet the consequences of this situation go far beyond the effect on this mother and daughter. Her daughter was in school with a cold for several days, and likely passed it on to her classmates. The mother, while she didn't yet have symptoms, quite likely would get the cold herself and pass it on to her elderly home care patient.

The lack of paid sick days affects all of us, and disproportionately affects the poor. Our families, neighbors, friends, and all of us deserve to be able to take a day off when we're sick and not have to worry about the impact it will have on our economic stability.

Thursday, September 16, 2010

6 months of health reform!

It's hard to believe it's been 6 months since the Affordable Care Act (aka Health Reform) was signed into law by President Obama. New benefits that have just started include:

Extension of coverage to young adults
Now young adults whose parents have insurance can be included on their parents' plans, meaning access to affordable health care for young adults up to age 26. For more information see the Young Invincibles website. The Young Invincibles were a critical voice for health reform and continue to work for better health access for young adults.

No more coverage exclusions for children with pre-existing conditions
Believe it or not, up until now children could be denied for coverage for pre-existing conditions, even conditions they were born with. In 2014, the same will be true for adults as well.

Restrictions on annual limits
Many people who have insurance find themselves facing astronomical bills after a serious illness. Starting now, insurers must pay at least the first $750,000 of expenses incurred in a year, and in 2014 these annual limits will be eliminated.

For more information see the Kaiser Health News website

Tuesday, July 27, 2010

New Directions

Hello to all! I am the new director of the NPA New York Local Action Network. Now that healthcare reform has become law, we have many exciting new directions in which to go. We will mostly be focusing on local and state-wide projects and plan to continue to work with our community partners to improve the health of all New Yorkers. Some legislation currently on the horizon that we support:

Sugar-Sweetened Beverage Tax - Obesity is a challenging problem for all of New York, especially among the poor. In the future, obesity and the diseases that come with it, including diabetes, hypertension, and heart disease will take up more and more of our health care dollars. Heavily sweetened beverages are a large source of calories that can lead to obesity, and by taxing them at a higher rate than other beverages we hope to discourage their consumption and also to raise much-needed revenue for obesity prevention programs. There are many competing interests against such a tax and it appeared to be off the table until recently, when Governor Paterson announced he would consider it again.

Midwifery Modernization Act - Maternity care in New York has become increasingly medicalized and C-section rates are skyrocketing, without any improvement in the health of women or babies. Midwives who specialize in home births offer a safe alternative for women who want to deliver in the comfort of their own home. Home births are safe when women are at low risk of complications and when attended by a qualified midwife. Current regulations require that midwives attending home births have a "written practice agreement" with an obstetrician. Unfortunately, this regulation does not improve the safety of women giving birth and serves only to limit their choices of where and how to deliver their babies because few obstetricians are willing to sign this agreement. We as physicians know that midwives are highly trained professionals who work in collaboration with other providers; a formal written practice agreement should not be required. All women should have the option of a home birth attended by a midwife. This legislation is currently on the Governor's desk awaiting his signature.

The New York City Paid Sick Time Act - Currently many workers have no paid sick days at their jobs. As a result, they risk losing valuable income if they don't go to work either to care for themselves or their children. This puts all of us at risk of contracting infectious diseases. Similar initiatives in other cities such as San Francisco have had minimal impact on business productivity.

Reproductive Health Act - Around the country, access to abortion services is under threat. The Reproductive Health Act seeks to change arcane state laws about abortion services and to regulate abortion under the same code as with all other legal medical procedures. It will also ensure that even if national laws about abortion change, New York will continue to offer abortion services up to 24 weeks, which is consistent with the landmark Supreme Court case (Roe v Wade) that legalized abortion throughout the country nearly 40 years ago. This law will allow women to consult with their doctors in privacy to make the best decisions for themselves. The legislature declined to move on this legislation in this past session.

Looking forward to working with you this year!


Sharon Phillips

Saturday, April 3, 2010

March 22 Health Insurance Reform March on Washington, DC

It was a rainy day and the buses were late but that didn't slow the momentum in the least. Two buses from Union Square set out carrying doctors, medical students, and other health care professionals to join hundreds more in Washington from around the country. The members of NPA-NY who were in attendance were Manisha Sharma, MD, Sharon Phillips, MD, Bill Jordan, MD, and Rafi Pristoop, MD.

The entire group first convened at Freedom Plaza where doctors, medical students, and nurses, from DC, New York, Vermont, Connecticut, Boston, Philadelphia, Virginia, Chicago, North Carolina, Florida, and California, gave personal testimonials about the need for Health Insurance Reform.

Next, we Marched to the Capitol in the pouring rain. Dr. Manisha Sharma led the crowd with spirited cheers using her megaphone. This is a great feat because although doctors are smart, they are generally rather dull people. So to get them yelling at the top of their lungs takes great persuasion and charisma. While we waited in line to enter the Senate Hart Building, where the Press Conference was to take place, we ate our soggy boxed lunches.

At the Press conference Senator Bingaman (D- NM), Rep. Jim McDermott MD (D- Seattle), Rep. Jan Shakowski ( D-IL) spoke along with leaders from Doctors For America, the American Academy of Pediatrics, the American Academy of Family Physicians, and Nurses Alliance, showing support for the historic bill signed into law. Dr. Rafi Pristoop got to stand on stage next to the speakers. Again, Dr. Sharma led the audience in with great spirit. Senator Bingaman even made the comment, "I've attended a lot of events in this room and I've never seen so much enthusiasm before."

After the Press Conference Doctors split up and spoke to their respective Senators and Congresspeople. The New York delegations sent doctors to the offices of Senator Schumer, Senator Gillibrand, Rep Yvette Clarke, Rep McMahon, Rep Murphy, Rep Owens, and Rep Towns.

The final event of the day was a happy hour at a bar where everyone got to celebrate and relax after over a year of dedication, fighting, and hard work.

Sunday, March 28, 2010

Thank You to Our Partners

Dear Friends, Partners, Colleagues, and Patients,

This week was truly historic. For the first time, doctors and community members stood together for health care reform. The lawmakers heard our voice and acted. Because of our work over the past year, nearly all Americans will gain access to guaranteed, quality, affordable care that improves our health.

We recognize that the law is not perfect and much work lies ahead. The first step is to call our elected officials and thank them. We also need to learn about the benefits of reform so that we can teach our patients, colleagues, friends, and families. The more we know, the better we can advocate for quality and affordable health care for all.

We look forward to continuing our work together in the pursuit of social justice.

In unity,
NPA NY Leadership


Thank you for making a place for physicians in your coalition. Here is a list of some of the many partners with whom we are grateful to have worked.

Democratic Club of Northern Manhattan
Downtown East for Obama
Make the Road
Queens County for Change
South Asians for Change
Westchester Health Care Reform Task Force

Tuesday, March 23, 2010

Victory in DC

300-strong. Today, March 22, 2010, we marched, rallied, and lobbied in DC to celebrate our victory, thank our Representatives, and press our Senators to get the job done. Dr. Manisha Sharma from NPA NY warmed up the crowd.

We owe our thanks to all our patients, community partners, elected officials, and colleagues on this momentous day.

Manisha Sharma of New York leads dozens of medical professionals in a rally showing support for the House health-care bill.

March 22, 2010

Manisha Sharma of New York leads dozens of medical professionals in a rally showing support for the House health-care bill.

Marvin Joseph-Washington Post

Monday, February 22, 2010

Feb 20 Brooklyn Bridge March for Health Care Reform on CBS!!!!

A coalition of NYC groups all part of Health Care for America Now!, including MoveOn, National Physicians Alliance, NYC for Change, NY Immigration Coalition and Citizen Action, marched across the Brooklyn Bridge and rallied in front of Wellpoint Insurance in downtown Manhattan, demanding that Congressional Democrats and President Obama finish the fight for real health care reform. For more on the rally, watch this video and listen to Manisha's wonderful speech.

Saturday, January 30, 2010

I'm sick of the politics. Patients need health care reform.

At this point it seems like everyone’s frustrated with health care reform. Liberals feel betrayed about the public option and worry that we’ll see little actual “reform.” Conservatives are skeptical about the proposals’ ability to control costs, and worry that expanding public programs without stronger cost controls will leave our country further in debt. Having debated compromises, and compromises of those compromises, many of us are left wondering whether health care reform even matters anymore. Well, as an American, I am disappointed in the broken political process; as a progressive, I worry my core values of justice and equity are being undermined; but as a doctor, I cannot give up on reform.

More than a year ago, Mr. Nelson*, a hypertensive man in his 50’s with two grown daughters and a college bound son, came in as a new patient. He had lost his job as a salesman and with it his health insurance. For awhile, he paid out of pocket for the medication prescribed by his previous doctor, but he could no longer afford them. The community health center where I work offers sliding scale payment and low cost medications, so when he began having severe headaches, he came in to see if we could help. His blood pressure was sky high and I was concerned that he could have a stroke, but he did not want to go to the emergency room fearing the costs. Instead, I wrote a few prescriptions, saw him several times over the next few months, and we finally got his blood pressure under control.

I saw Mr. Nelson again a few weeks back, and he has still been unable to find work. His wife’s employer does not offer health insurance, and with her salary and his unemployment benefits, their income is too high for Medicaid. He could purchase coverage on the non-group market if it was affordable, but he has looked and this is not an option. Over the past year, I have been worried about his daytime fatigue and snoring, and I suspect he has obstructive sleep apnea. However, he cannot afford the thousands of dollars for a sleep study and respiratory equipment, so he must delay this medical care. It is a gap that the health center cannot fill. Each visit he is upbeat about his family and his blood pressure, but I cannot help but worry that sleep apnea is causing permanent damage to his heart and lungs.

I have other patients like Mr. Nelson, and I’m sure there are many other Americans out there as well, who are just getting by, and maybe cutting their pills in half to make them last, and delaying medical care as they focus on more pressing matters like putting their kids through school. The health care horror stories are heart breaking, but thinking about my patients on the verge of a bad outcome or one illness away from bankruptcy, I feel impassioned to demand reform now. We cannot wait for the perfect plan. A health insurance exchange with subsidies for private insurance is not the same as a public health insurance option, but it would offer affordable coverage to Mr. Nelson. If 45,000 preventable deaths annually are attributable to lack of health insurance, the Senate bill, which covers 2/3 of the uninsured with subsidized private insurance and expanded Medicaid, could potentially save 30,000 lives. If this is not the purpose of health insurance reform, I’m not sure what is.

Many are calling for the House to pass the Senate bill, and fix issues like the level of premium subsidy via reconciliation. This won’t remake the American health care system into a model of efficiency and equitability, but it does move us from debate to action. It will help 30 million Americans who are uninsured. It will provide security to those with private insurance. It will strengthen primary care, prevention, and wellness. Waiting any longer is just not an option.

*I thank Mr. Nelson for allowing me to share his story. I have changed his name and other minor details in order to protect his privacy.

Families USA 2010

NPA doctors came out for the Families USA Health Action 2010 Conference in DC this week. Featured here are Drs. Arkoosh, Sriram, and Silver-Isenstadt at a rally in the Dirksen Senate Building. Drs. Aaron Fox, Sharon Phillips, Cameron Page, and William Jordan from our local New York group fanned out for interviews with radio talk show hosts from across the country who came for the conference.

Dr. Cameron Page on Progressive Blend Radio

Hear Dr. Page here.

Dr. Aaron Fox on Warren Ballentine Show

Long show, skip to hour 2 minute 34.

Dr. Aaron Fox on the Radio

Quoted from University of New Mexico/Talk Radio News Service on January 29, 2010 | ShareThis

Dr. Aaron Fox with the National Physicians Alliance explains what his organization does, and details how health care reform would benefit Americans. (5:32)

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January 29, 2010

Friday, January 29, 2010

Dr. Sharon Phillips on the Radio

Dr. Sharon Phillips spoke on Hard Knock Radio, out of the Pacifica affiliate in Berkeley, California.

Davey D continues to report from the Families USA Health Action 2010 Conference. First he talks with Congressman James E. Clyburn (D-SC) about passing legislation to help poor people and his thoughts on Katrina and Haiti. Then he talks with Democratic Michigan Senator Debbie Stabenow on how Michigan will come back from this economic crisis. Finally, an interview about health care and reproductive rights with Dr. Sharon Phillips.

Wednesday, January 27, 2010

Haiti Benefit Success

See below for a message from our partner in the Haiti Benefit. Dr. Manisha Sharma pictured at the event.


Thanks to all those who attended our "Stand with Haiti" grassroots benefit. It was a moving night, perhaps best expressed in the words of an earthquake survivor who had just arrived in New York.

Soft-spoken and eloquent, she told her story in her native Creole. She reminded all of us how helpful each contribution was to the people of Haiti in rebuilding their nation. How she had seen so many children who were tired and sad, and who have no home to return to.

Through the generous contributions of our wonderful New York City community, we were able to raise $2,250 to help these children rebuild their future. Amity Hall, who had initially pledged 10% of their revenue, ended up donating much more, citing the worthiness of the cause.

Our heartfelt thanks goes out to them and to you. We know you took time out of your busy schedules to attend our event. And for those who could not attend, or would like to give more, please visit Partners in Health online, at

With kind regards,
Aliya Quraishi
NYC for Change

Tuesday, January 26, 2010

Bronx Rally

I spoke to a small but enthusiastic Bronx crowd who braved the cold to support health care reform. This was one of hundreds of coordinated rallies nationwide on Tuesday, January 26, 2010. Rep Engel sent Staffer Shirley Saunders to voice his support. -William Jordan, MD

Brooklyn Rally

Dr. Manisha Sharma spoke at the Emergency Rally for Health Care Reform on the steps of Brooklyn Borough Hall on Tuesday, January 26, 2010.

See minute 5:36 for the beginning of her speech:

Continued here:

Thursday, January 21, 2010

Stand with Haiti: Partners in Health Benefit

Stand with Haiti: Partners in Health Benefit
January 26, 2010
Amity Hall
80 West 3rd Street
New York NY

Co-hosted by Asian Pacific Americans for Progress, National Physicians Alliance, NYCforChange, South Asians for Opportunity, Tribeca for Change, Queens for Obama, Upper West Side Baby Boomers for Obama's Agenda and Voterbook.